Upcoding is a serious healthcare fraud charge that involves fraudulent billing practices aimed at wrongfully increasing the amount that a medical facility collects for performing a service. If a medical provider submits bills with questionable items, an investigation for fraudulent billing may be launched against the office and healthcare fraud charges may follow. Such events should be discussed with a Ft. Lauderdale criminal lawyer.


What is upcoding?

Medical facilities are expected to submit accurate and truthful records of the treatments, procedures and services they provide in caring for their patients. Each individual procedure has a specific code used to identify it, and the healthcare facility will use these codes to bill insurance companies or government programs for services they’ve provided to policyholders.

Upcoding is when a doctor, health care facility, or medical supply/service company renders a service to a patient and then submits a bill using a code that corresponds to a higher cost service. Typically the services are similar in nature but have differences in charges, such as a normal consultation versus an extended consultation.

Detecting Cases of Upcoding Fraud

Through audits and whistleblowers, upcoding may be detected and those accused of committing these fraudulent acts could face healthcare fraud charges. Audits may be conducted at random in many cases, so it’s important to always keep accurate records to answer any inconsistencies or inquiries regarding billing of services. A Ft. Lauderdale criminal lawyer may utilize these records when defending against charges of fraudulent billing.

A whistleblower is an informant with knowledge of a healthcare provider’s potentially fraudulent billing practices. These informants are often compensated for their information if a case of fraud is found and results in a recovery. The whistleblower may receive a percentage of the recovery. If an individual brings forth allegations of fraudulent practices, consult a Ft. Lauderdale criminal lawyer to begin addressing the accusations.

Consult a Ft. Lauderdale Criminal Lawyer if Facing Healthcare Fraud Charges

If facing upcoding healthcare fraud charges, consider legal counsel with a Ft. Lauderdale criminal lawyer to help protect rights. Businesses can face audits of billing records and investigation of facilities, events for which a lawyer can offer counsel to businesses.

In 2007 the U.S. government launched a special strike force to crack down on healthcare and Medicare fraud cases in South Florida. In just two years the Strike Force made 146 arrests and obtained $186 million in fines and recoveries. South Florida has been a target of scrutiny for healthcare fraud for years, and medical professionals must remain vigilant when it comes to their billing and assessment of patient records and treatment.

Medical professionals facing accusations for upcoding in their billing practices should know their rights to fair treatment during the investigation. Ft. Lauderdale criminal lawyer Robert Malove is here to help medical professionals address healthcare fraud charges or investigations and protect their rights. Contact the office at 954-861-0384.